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Caregiver Guide: Sleep Problems

Understanding the Problem

People of all ages can have trouble falling asleep or staying asleep or have poor quality sleep (insomnia). There are many possible causes including stress, changes in schedule, diet, or as a side effect of medicines. As people age, they generally spend less time in the deepest stages of sleep. After age 40, sleep becomes lighter and it is easier to wake up.

Sleep is considered a problem only when the person is not satisfied with their sleep, when the person feels drowsy or has other related symptoms the following day, or when the sleep problem suggests a serious underlying illness.

Sometimes making a few simple lifestyle changes, such as getting more exercise during the day, is all that is necessary for a person to begin sleeping soundly. At other times a health problem such as stress, hormonal changes, poor nutrition, or drinking alcoholic beverages may cause insomnia.

The most common reason for a sudden change in sleep patterns is emotional stress or nervousness. Depression can keep people up and awakes them at early hours.

Dementia frequently alters sleep/wake patterns. A person with dementia may sleep during the daytime then stay awake and even wander at night. Medicines such as diuretics, antidepressants, anti-anxiety medicines, painkillers, and drugs for Parkinson's disease can also affect sleep patterns.

Sometimes people show odd behaviors while sleeping, which may be noticed only by a spouse or companion. Behaviors such as moving the arms or legs, kicking, loud snoring, or choking sounds are signs of possible sleep disorders. These should be brought to the healthcare provider’s attention.

One disorder to be concerned about is sleep apnea, a condition in which people briefly stop breathing while asleep. This causes them to wake up many times during the night. Sleep apnea can cause fatigue the next day and is associated with high blood pressure, heart disease, and heart failure.

Your goals are to:

Encourage a set routine for going to bed and waking up

Check all medicines to see if they could affect sleep

Check the patterns of use of caffeine and alcohol to see if they might be affecting sleep

Make the bedroom safe and comfortable

Click on each of the topics below to read more.

When to Get Professional Help

Call the healthcare provider immediately or go to the emergency room if any of the following symptoms occur

Sleep emergencies are not common. However, the following situation has been known to happen at night or bedtime:

A sudden change in mood

If the person you are caring for wakes suddenly during the night and acts agitated or confused, it is important to call a healthcare provider right away. This could be a sign of a serious medical illness or a side effect of a prescription medication.

Call the healthcare provider during office hours to discuss the following problems

Sleep is not satisfying

Ask the older person to explain what is troublesome about sleep.

Sleep or fatigue cuts into daytime activities

It is normal to fall asleep during quiet time, such as watching TV, but falling asleep in the middle of a conversation is not. Excessive daytime sleepiness is also abnormal. Falling asleep while driving is abnormal and dangerous.

You see or hear strange behaviors during the older person’s sleep

Loud snoring, choking sounds, short periods when breathing stops, gasping, and leg and arm movements during sleep could all be signs of sleep apnea or other sleep disorders.

Know the answers to the following questions before calling the healthcare provider

How long has sleeping been a problem?

What other medical conditions does the older person have?

What medicines are being taken? (Include prescription and non-prescription medications.)

Could emotional stress be affecting sleep, such as the recent death of a family member?

Is the older person feeling sad, depressed, or anxious?

Is snoring a problem? If yes, do you notice daytime drowsiness and/or choking, gasping sounds during sleep?

Are there complaints of indigestion, chest pain, or shortness of breath when the older person wakes up during the night?

Is there evidence of alcohol, caffeine, or nicotine use?

What You Can Do to Help

There are many things that you can do on your own to help an older person with sleep problems.

Use sleep medicines with caution

Read the label on the medicine bottle carefully. Most prescribed sleep medicines are meant to be taken for no longer than two or three weeks. After three weeks, they lose effectiveness and can cause drowsiness during the day. Over-the-counter sleeping pills can cause dry mouth, constipation, urinary problems, and confusion.

Help the older person maintain a regular sleep/wake schedule

As much as possible, older people should get up and go to bed around the same time every day. But it is also important that they go to bed when they are sleepy. There is no need to lie in bed awake worrying about not sleeping.

Encourage the older person to get out of bed if not asleep in 30 minutes

Getting out of bed and going into another room for a short period can help people who are having trouble sleeping. Listening to music or doing some light reading often helps feelings of tiredness to return. However, it is important to avoid bright light during these periods.

Encourage the older person to limit napping

Naps of up to one hour are often helpful. Naps taken in the middle of the day (around noon) are the most effective. However, napping for more than an hour will make it more difficult for the older person to sleep at night.

Encourage daytime exercise

Exercise is a good remedy for poor sleep. A brisk walk in the afternoon is best. However, exercising just before going to bed can cause difficulty in getting to sleep.

Help the older person to limit or cut out alcohol, caffeine, and nicotine

All these substances can interfere with sleep.

Make the sleep environment a relaxing place

Encourage the older person not to use the bed to eat, read, or watch TV. When the bedroom is used just for sleeping, it becomes associated with sleep. This can help the older person feel sleepy when in the room.

Help the older person develop a bedtime routine

Activities like washing the face, brushing teeth, or other nightly routines before bed can help a person relax and prepare for bed.

Make the bedroom safe and comfortable

Sometimes the noise of a fan running or a “white noise” machine helps people sleep. Have a nightlight in case the older person wakes up confused or agitated. For people who wander at night, secure doors and windows.

Keep a diary of the older person’s sleep

If sleeplessness is a problem, keep a record of the sleep patterns for several weeks to review with the healthcare provider. Record the following information on a daily basis:

Times waking up and going to bed

How long it took to fall asleep

The number of times awake during the night and for how long

What woke the older person during the night

Any strange behavior during sleep, such as choking or gasping sounds, stopped breathing, or movements of the legs

When and how long naps are

Use of alcohol, caffeine, or sleeping pills.

A two-week sleep diary can help the healthcare provider understand the problem and determine what treatments would be helpful. Sometimes a sleep diary shows that the older person’s sleep is better than you thought.

Carrying Out Your Plan

Problems you might have carrying out your plan

Even when you have excellent plans, there are obstacles or problems that may prevent you from carrying them out. Here are some examples and responses..

"If my uncle stops taking sleeping pills, he won't be able to sleep."

Long-term use of sleeping pills may be contributing to or even causing the problems with sleep.

"Sleeping problems are normal for old people."

This is not true. Although there are some changes in sleep as people get older, most sleeping problems can be solved or improved.

"My mother always takes a nap before dinner."

The nap may be the reason for being unable to sleep at night. If the nap is a needed rest period, then it is okay. If napping is because of boredom, it may lead to less sleep at night.

Think of other problems you might have carrying out your plan

What other problems could get in the way of doing the things suggested in this section? For example, will the older person cooperate? Will other people help? How will you explain your needs to other people? Do you have the time and energy to carry out this plan?

You need to make plans for solving these problems.

Checking on Progress

Progress may be slow, especially at first. If you are setting up new routines to promote sleep, it usually takes time for people to get used to new routines and for the routines to be effective. Be on the lookout for sleep problems related to medical conditions or disorders, like sleep apnea, which require medical treatment.

Set realistic goals. Someone who has slept only four to five hours a night for years is unlikely to suddenly sleep for eight hours.

What to do if your plan isn't working

Be sure you have tried all of the suggestions in the “What You Can Do to Help” section and be realistic about how quickly you can expect change. Brainstorm ideas of your own. You may find the best approach through trying different methods.

If problems with sleep are increasing and are of major concern to the older person, ask the healthcare providers for help. Tell them what you have done and what the results have been.